BILL NUMBER: AB 272 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 7, 2011
INTRODUCED BY Assembly Member Monning
FEBRUARY 7, 2011
An act to amend Section 12923.5 of, and to repeal Sections
12693.925 and 12693.95 of, the Insurance Code, and to amend
Section 14148.8 of the Welfare and Institutions Code,
relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 272, as amended, Monning. Health care coverage:
agency: agencies: reports.
Existing law requires the Managed Risk Medical Insurance Board to,
by January 20, 2004, report to the Legislature specified information
with regard to the State Children's Health Insurance Program.
Existing law requires the board to provide, by April 15, 1998, a
proposal relating to drug and alcohol treatment programs for
children.
This bill would delete those obsolete provisions.
Existing law requires the Department of Managed Health Care and
the Department of Insurance to maintain a joint senior level working
group to ensure clarity for health care consumers about who enforces
their patient rights and consistency in the regulations of these
departments. Existing law requires the working group to report its
findings for review by the Insurance Commissioner and the Director of
the Department of Managed Health Care for review and approval and
submission every 5 years to the Legislature.
This bill would delete those reporting requirements.
Existing law requires the State Department of Health Care Services
to provide the Legislature an annual report summarizing data
reported by alternative birth centers, as specified.
This bill would delete that reporting requirement.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 12693.925 of the Insurance Code is repealed.
SEC. 2. Section 12693.95 of the Insurance Code is repealed.
SEC. 3. Section 12923.5 of the Insurance Code is amended to read:
12923.5. (a) The Department of Managed Health Care and the
Department of Insurance shall maintain a joint senior level working
group to ensure clarity for health care consumers about who enforces
their patient rights and consistency in the regulations of these
departments.
(b) The joint working group shall undertake a review and
examination of the Health and Safety Code, the Insurance Code, and
the Welfare and Institutions Code as they apply to the Department of
Managed Health Care and the Department of Insurance to ensure
consistency in consumer protection.
(c) The joint working group shall review and examine all of the
following processes in each department:
(1) Grievance and consumer complaint processes, including, but not
limited to, outreach, standard complaints, including coverage and
medical necessity complaints, independent medical review, and
information developed for consumer use.
(2) The processes used to ensure enforcement of the law,
including, but not limited to, the medical survey and audit process
in the Health and Safety Code and market conduct exams in the
Insurance Code.
(3) The processes for regulating the timely payment of claims.
SEC. 4. Section 14148.8 of the Welfare and
Institutions Code is amended to read:
14148.8. (a) The State Department of Health Care Services shall
provide Medi-Cal reimbursements to alternative birth centers for
facility-related delivery costs at a statewide all-inclusive rate per
delivery that shall not exceed 80 percent of the average Medi-Cal
reimbursement received by general acute care hospitals with Medi-Cal
contracts and shall be based on an average hospital length of stay of
1.7 days. The reimbursement rate shall be updated annually and shall
be based on the California Medical Assistance Commission's annually
published legislative report of average contract rates for general
acute care hospitals with Medi-Cal contracts. However, the
reimbursement shall not exceed the alternative birth center's charges
to any non-Medi-Cal patient for similar services.
(b) In order to be eligible for reimbursement pursuant to this
section, an alternative birth center shall satisfy the following
criteria as determined by the state department:
(1) At least 150 patients or 50 percent of the patient caseload
served at the center each year, whichever is less, shall be Medi-Cal
patients and low-income patients.
(2) The facility shall be currently certified as a comprehensive
perinatal services provider. If not currently certified, the facility
shall be certified with the first year of operation.
(3) The facilities may utilize certified nurse midwives, certified
nurse practitioners, and clinical nurse specialists where
appropriate.
(4) The facility shall meet the standards for certification
established by the National Association of Childbearing Centers,
including those relating to the proximity and involvement of
hospitals, obstetricians, and pediatricians.
(5) The facility shall establish and maintain a quality assurance
program.
(6) The facility shall maintain newborn followup care for at least
one year.
(7) The gathering of data and preparing reports as required in
subdivision (c).
(c) (1) Each alternative birth center awarded reimbursement
pursuant to this section shall gather data and annually report
outcome measures relating to the safety, cost-effectiveness, and
patient acceptance of the center to the department to be made
available upon request.
(2) The report shall include data on the incidence of maternal and
infant death, preterm newborns, low birth weight newborns, maternal
complications, newborn complications, cesarean sections,
forcep-assisted deliveries, deliveries involving use of anesthesia,
months of prenatal care, family involvement in childbirth,
breast-feeding, infant immunizations, well baby care, adjusted cost
per case for deliveries performed at the center, and cost per case
for women transferred to hospitals for delivery.
(3) The department shall, to the extent information and resources
are available, as determined by the department, compare the data
provided by the centers with information furnished by other providers
of prenatal and delivery services. The department shall use the
comparative data to determine for the Medi-Cal program whether
alternative birth centers are cost-effective, improve access to
prenatal care, reduce the anticipated incidence of maternal and
newborn complications, and have a high degree of patient acceptance.
(d) The director shall administer this section and establish
standards, procedures, and reimbursement rates, as the director deems
necessary in carrying out this section. The establishment of the
reimbursement rates is not required to be adopted as regulations
pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code).
(e) Nothing in this act shall alter the scope of practice for any
health care professional or authorize the delivery of health care
services in a setting or in a manner not authorized by the Health and
Safety Code or the Business and Professions Code.